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General NPI Number Information
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NPI Number | 1366769440
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Entity Type | Individual
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Provider Name | KARLA DIANE BOGGS LMT
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Gender | Female
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Dates
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Enumeration Date | 04/28/2010
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 1922 WALTON NICHOLSON PIKE
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City | INDEPENDENCE
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State | KY
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Zip | 41051-7901
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Country | US
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Telephone | 859-363-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 7101 MANDERLAY DR
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City | FLORENCE
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State | KY
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Zip | 41042-2623
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Country | US
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Telephone | 859-322-2249
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | KY-3465
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 33.017830 A-B
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License Number State | OH
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